Provider Demographics
NPI:1699106211
Name:PATEL, MUDRA
Entity type:Individual
Prefix:MRS
First Name:MUDRA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1714
Mailing Address - Country:US
Mailing Address - Phone:973-253-8301
Mailing Address - Fax:
Practice Address - Street 1:371 VAN BUSSUM AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2419
Practice Address - Country:US
Practice Address - Phone:973-772-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-07
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03613600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist